THE IMPACT OF SHIFT WORK ON THE METABOLISM AND CIRCADIAN RHYTHM IN NURSES AND MEDICAL TECHNICIANS.

Providing in-patient nursing care inevitably involves shift work and shift patterns have been identified as an important factor in determining well-being and satisfaction among nurses. Shifts of 12 h or longer have become increasingly common for nurses in hospitals in some European countries. Longer shifts offer a potential to benefit from a compressed working week, with fewer work days and more days off-work, lower commuting costs, and increased flexibility. Most people find shift work less desirable compared to standard working hours. A cross-sectional cohort study was conducted at the Mostar University Hospital in 2019. A total of 157 subjects participated in the study, 22 (14%) of which were male (medical technicians) and 135 (86%) female (nurses). The mean age of study subjects was 33.3 years (min=20, max=54, SD=8.033). Results of this study suggested that nurses working irregular rotating shifts, with more family members to look after and more than 18 years of professional experience were affected by sleep disturbances between shifts. The study showed that shift work nurses had significantly higher levels of cortisol and prolactin compared with first-shift nurses/medical technicians. The results of this study are expected to stimulate further studies of sleep disturbances among shift nurses.

Accuracy of Modified Alvarado Score, Eskelinen Score and Ohmann Score in Diagnosing Acute Appendicitis.

INTRODUCTION: By processing the data of a large number of patients with abdominal pain, diagnostic scores whose implementation attempts to facilitate acute appendicitis diagnostics were developed. Modified Alvarado score, Ohmann score and Eskelinen score are used as assistance when setting the diagnosis and making a decision to undertake surgery. AIM: To assess accuracy of Alvarado score, Ohmann score and Eskelinen score in diagnosing acute appendicitis and to establish connection of total score of these scoring systems with histopathological degree of appendicitis. SUBJECTS AND METHODS: A cross-sectional study was conducted at the Department of Surgery of University Clinical Hospital Mostar. The study included 70 patients who underwent appendectomy and were scored before surgery. All tested persons were examined by experienced surgeon who took anamnesis, physical status and ordered laboratory diagnostic tests. Appendicitis was excluded or confirmed by means of histopathological diagnostics, and the degree of appendicitis was determined. RESULTS: According to accuracy parameters (sensitivity, specificity, negative and positive predictive value), the score which was of highest value was Ohmann score, followed by Eskelinen score, while the lowest value was the one of modified Alvarado score. Total score in all three scoring systems follows the degree of appendicitis, but statistical significance was proven only for Ohmann and Eskelinen scores. CONCLUSION: Ohmann and Eskelinen scores can be useful in diagnosing acute appendicitis, predicting the degree of appendicitis, as well as assistance when making decision to undertake an operative procedure. Modified Alvarado score in our subjects did not prove sufficient value. Diagnostics of acute appendicitis still must be led by contemporary algorithms in which diagnostic scoring is implemented.

The Interplay of Cx26, Cx32, Cx37, Cx40, Cx43, Cx45, and Panx1 in Inner-Ear Development of Yotari (dab1-/-) Mice and Humans.

We investigated DAB1-protein deficiency in the inner-ear development of yotari in comparison to humans and wild-type (wt) mice by immunofluorescence for the expression of connexins (Cxs) and the pannexin Panx1. The spatial and temporal dynamics of Cx26, Cx32, Cx37, Cx40, Cx43, Cx45, and Panx1 were determined in the sixth and eighth weeks of human development and at the corresponding mouse embryonic E13.5 and E15.5, in order to examine gap junction intercellular communication (GJIC) and hemichannel formation. The quantification of the area percentage covered by positive signal was performed for the epithelium and mesenchyme of the cochlear and semicircular ducts and is expressed as the mean ± SD. The data were analysed by one-way ANOVA. Almost all of the examined Cxs were significantly decreased in the cochlear and semicircular ducts of yotari compared to wt and humans, except for Cx32, which was significantly higher in yotari. Cx40 dominated in human inner-ear development, while yotari and wt had decreased expression. The Panx1 expression in yotari was significantly lower than that in the wt and human inner ear, except at E13.5 in the mesenchyme of the wt and epithelium and mesenchyme of humans. Our results emphasize the relevance of GJIC during the development of vestibular and cochlear functions, where they can serve as potential therapeutic targets in inner-ear impairments.

Association of colorectal carcinoma and metabolic syndrome.

Aim Colorectal carcinoma is one of the most common neoplasms, especially in Western countries and those with westernisation. On the other hand, high rate of metabolic syndrome (MetSy) has also been noticed, as well as in Western countries. It seems like these two conditions are somehow connected. In this study, we wish to explore some characteristics of colorectal carcinoma and its correlation with MetSy. Methods In this retrospective study the data were taken from medical records of 67 patients with colorectal carcinoma, and for 30 healthy controls. Input parameters of patients were compared mutually, as well as with parameters of healthy, control examinees that had negative screening colonoscopy for neoplasm. Results Average age of patients was 68 years. The most frequent localisation of neoplasm was on rectum (53.7%) and most frequent level was Dukes C (38.8%). The patients had MetSy more frequently when compared with controls (p=0.048), and also they had more MetSy components (p=0.006). The link between MetSy and localisation of neoplasm was not found, neither with its pathohystological characteristics. Conclusion Patients with MetSy should be warned about the increased risk of colorectal carcinoma, and, in this way, motivated for earlier and more frequent screening colonoscopies, as well as of a change of unhealthy lifestyle.

CD25+ FOXP3+ and CD4+ CD25+ cells distribution in decidual departments of women with severe and mild pre-eclampsia: Comparison with healthy pregnancies.

PROBLEM: The aim of this study was to quantify and compare the distribution of regulatory CD25+ FOXP3+ and activated CD4+ CD25+ T cells in decidua basalis and parietalis of severe and mild pre-eclampsia (PE) to normal healthy pregnancies. METHOD OF STUDY: Decidual tissue (decidua basalis and parietalis) of 13 women with mild PE, 15 women with severe PE, and 19 women with healthy term pregnancies were analyzed by immunohistochemistry and double immunofluorescence. RESULTS: The total number of CD25+ FOXP3+ cells/mm2 in decidua basalis was decreased in the severe and mild PE versus normal pregnancy group. The total number of CD4+ CD25+ cells/mm2 in decidua basalis was decreased in the severe PE versus normal pregnancy group. The number of CD25+ FOXP3+ and CD4+ CD25+ cells in decidua parietalis was decreased in both PE groups. CONCLUSION: Our data suggest that immunological changes of PE reflect on decidua basalis and parietalis and emphasize the importance of characterizing T cells in both decidual departments.

Trends in frequency of surgical procedures at Department of Otorhinolaryngology and Maxillofacial Surgery of Mostar University Hospital, Bosnia and Herzegovina (2013-2017).

Aim To determine whether there has been a change in frequency of selected otorhinolaryngology - head and neck surgical procedures during a 5-year period. Methods Comparative cross-sectional analyses of surgical candidates and procedures performed at the Department of Otorhinolaryngology and Maxillofacial Surgery during the period 2013‒2017 were done. Data on patients' demographics and cases of selected surgical procedures were extracted from the operating room log books. Patients' average age, male:female ratio, and the percent share of all surgical procedures for each selected surgical procedure for each studied year were calculated. Results In comparison with the year 2013, the year 2017 showed no significant difference in age or sex of patients who underwent selected surgical procedures, increase of the number of all operations and the number of investigated selected operations, increase in the share of tonsil surgery, nasal septum and pyramid surgery, nasal polyposis surgery, parathyroid gland surgery, otoplasty, cochlear implantation, laryngeal surgery, and tracheotomy, and decline in the share of thyroid gland surgery, middle ear microsurgery, neck dissection, surgery of parotid gland, and surgery of neck cysts. Conclusion Our finding of variations in utilization of some studied procedures provides a basis for future discussions, research and provision of health care services. Used data are specific to two studied cantons and do not represent a nationally representative database. The generalisability of the present results to Bosnia and Herzegovina as a whole might be limited. Therefore, similar future investigations conducted in other large hospitals in our country are warranted.

Anthropometric characteristics and traffic accident circumstances of patients with isolated whiplash injury in University Clinical Hospital Mostar.

Aim To investigate anthropometric characteristics and traffic accident circumstances of subjects with isolated whiplash injury. Methods This cross sectional study involved 75 subjects from traffic accidents with isolated whiplash injury classified by Quebec Task Force (QTF). Anthropometric data were collected as well as claims about circumstances of traffic accidents. Results Distribution of 1st (28; 37.3%), 2nd (25; 33.3%) and 3rd (22; 29.3%) grade of whiplash injury was almost equal. Females had smaller anthropometric measurements than males; neck circumference was the most significant difference between males and females in the context of whiplash injury. The most frequent collision mechanism was impact to front (26; 34.7%) or to rear end (26; 34.7%) of a small passenger's car. Assertions of participants were that their car damage was significant (37; 49.2%) or total (24; 32%). A total of 38 (50.7%) participants claimed that they were not wearing safety belt and 52 (69.3%) did not find themselves responsible for accident. Conclusion Driving habits of our participants facilitate incidence of whiplash injuries, especially in vulnerable groups such as women and elderly.

Isometric muscle fatigue of the paravertebral and upper extremity muscles after whiplash injury.

BACKGROUND: Whiplash-associated disorders (WAD) result from injury of neck structures that most often occur during traffic accidents as a result of rapid acceleration-deceleration. The dominant symptoms manifest in the musculoskeletal system and include increased fatigue. Because of the frequency of whiplash injuries, a simple, cheap and useful diagnostic tool is needed to differentiate whiplash injury from healthy patients or those faking symptoms. OBJECTIVES: To determine muscle fatigue in patients with whiplash injury in six body positions. DESIGN: Analytical cross-sectional study. SETTING: Emergency center, university hospital. PATIENTS AND METHODS: We studied patients with whiplash injury from vehicular traffic accidents who presented to the emergency center within 6 hours of sustaining the injury. We determined whiplash injury grade according to the Quebec Task Force (QTF) classification and measured isometric muscle endurance in six different body positions. Control subjects for each patient were matched by age, gender and anthropomorphic characteristics. Cut-off values were determined to distinguish patients with whiplash injury from controls and for determination of injury grade . MAIN OUTCOME MEASURE(S): QTF grade, time to muscle fatigue in seconds. RESULTS: From September 2013 to September 2016, we enrolled 75 patients with whiplash injury and 75 matching control subjects. In all six positions, the patients with whiplash injury felt muscle fatigue faster than equivalent controls (P < .05) and the time to onset of muscle fatigue decreased with increasing injury grades in all six positions. Assignment to the patient or control group and to injury grade could be predicted with more than 90% accuracy on the basis of time to muscle fatigue. The most efficient position was the highest injury grade, by which 99.9% of the patients were accurately categorized. Isometric muscle endurance correlated with whiplash injury grade in all six positions (P < .01). CONCLUSION: Under clinical conditions, muscle endurance and the appearance of isometric muscle fatigue during testing can be a useful indicator of whiplash injury and grade. LIMITATIONS: The size of the sample was small. An objective parameter such as electromyography is needed to confirm isometric muscle fatigue.

Morning cortisol levels and glucose metabolism parameters in moderate and severe obstructive sleep apnea patients.

Obstructive sleep apnea (OSA) has been associated with dysregulation of the hypothalamic-pituitary-adrenal axis and alterations in glucose metabolism with increased risk for type 2 diabetes. The aim of the current study was to compare morning plasma cortisol levels and glucose metabolism parameters between moderate (apnea-hypopnea index (AHI): 15-30 events/h) and severe OSA patients (AHI >30 events/h), with respective controls. A total of 56 male OSA patients, 24 moderate (AHI = 21.1 ± 5.3) and 32 severe (AHI = 49.7 ± 18.1), underwent a full-night polysomnography, oral glucose tolerance test (OGTT), and measurement of morning plasma cortisol levels. These groups were compared to 20 matched subjects in a control group. Morning plasma cortisol levels were statistically lower in severe OSA group than in moderate OSA and control groups (303.7 ± 93.5 vs. 423.9 ± 145.1 vs. 417.5 ± 99.8 pmol/L, P < 0.001). Significant negative correlations were found between morning plasma cortisol levels and AHI (r = -0.444, P = 0.002), as well as oxygen desaturation index (r = -0.381, P = 0.011). Fasting plasma glucose (5.0 ± 0.5 vs. 5.4 ± 0.7 vs. 4.9 ± 0.6 mmol/L, P = 0.009) was higher in the severe OSA group compared to moderate OSA and controls. Homeostasis model assessment insulin resistance (HOMA-IR) was higher in the severe OSA group compared to moderate OSA and controls (4.6 ± 3.7 vs. 2.7 ± 2.0 and 2.2 ± 1.8, respectively, P = 0.006). In conclusion, our study showed that morning plasma cortisol levels measured at 8 a.m. were significantly lower in severe OSA patients than those in moderate OSA group and controls. Morning plasma cortisol levels showed a negative correlation with AHI and oxygen desaturation index. Additionally, this study confirmed the evidence of glucose metabolism impairment in moderate and severe OSA patients, with more pronounced effect in the severe OSA patients group.